Odontogenic

cysts
Y3OralPathP44

1
OBJECTIVES
 To understand the pathogenesis, etiology
and histopathology of Gingival cysts,
Lateral Periodontal and Botryoid
odonotogenic cyst.

2
Gingival cyst and
midpalatal cyst of
infants

3
Clinical features
 Frequently seen in new born infants

 Rare after 3 months of age

 Undergo involution and disappear
 Rupture through the surface epithelium and exfoliate

 Along the mid palatine raphe  Epstein’s pearls

 Buccal or lingual aspect of dental ridges  Bohn’s

nodules

 Fromm (1967)  gingival cysts are found only on the

crest of dental ridges
4
 2-3 mm in diameter

 White or cream coloured

 Single or multiple (usually 5 or 6)

 Absent in the soft palate  consolidation of soft

palate and uvula takes place by subepithelial
mesenchymal merging without direct apposition and
breakdown of epithelium. Burdi (1968)

5
Pathogenesis
Gingival cyst of infants

 Arise from epithelial remnants of dental

lamina (cell rests of Serre)

 Have the capacity to proliferate, keratinize

and form small cysts Moscow and Bloom
(1983)

6
Midpalatal raphe cyst

 Arise from epithelial inclusions along the line of

fusion of palatal folds and the nasal process
 Usually atrophy and get resorbed after birth
 May persist to form keratin filled cysts

 May represent abortive glandular differentiation 

cyst formation Burke (1966)

7
Histopathology
 Round or ovoid

 Smooth or undulating outline

 Thin lining of stratified squamous

epithelium with parakeratotic surface

 Cyst cavity filled with keratin

(concentric laminations with flat nuclei)

 Flat basal cells

 Epithelium lined clefts between cyst

and oral epithelium

 Oral epithelium may be atrpohic

8
Gingival cyst of
adults

9
Clinical features
 Frequency
 0.5% (Shear)
 May be higher as all cases may not be submitted to
histopathological examination

 Age
 5th and 6th decade

 Sex
 No predilection

 Site
 Much more frequent in mandible
 Premolar-canine region
10
 Clinical presentation

 Soft and fluctuant

 Well circumscribed, slowly enlarging, painless swelling

 Attached gingiva or interdental papilla

 Facial aspect

 Usually less than 1 cm

 Smooth surface

 Colour of overlying mucosa  normal or bluish

 Adjacent teeth usually vital

 Slight erosion of surface of the bone

11
12
Radiological features
 No change

 Faint round shadow

13
Pathogenesis
 Ritchey and Orban, 1953
 Odontogenic epithelial cell nests

 Traumatic implantation of surface epithelium

 Cystic degeneration of deep projections of surface

epithelium

 Traeger, 1961
 From glandular elements
14
Histopathology
 Extremely thin epithelium resembling REE
 1-3 layers of flat to cuboidal cells
 Darkly staining nuclei

Or

 Thicker stratified squamous epithelium without rete ridges

17
 Epithelial cells may show
 Pyknotic nuclei
 Perinuclear cytoplasmic vacoulization
 Atrophic with ghost outlines

 Localized epithelial thickenings or plaques

 Some protrude in the cystic lumen
 Some extend into fibrous cyst wall
 Cells
 Whorled configuration
 Compact and fusiform
 Swollen and clear (water clear cells)

 Low columnar cells on the surface of epithelium 

origin from ameloblasts
18
Attachment of epithelium to connective tissue is
tenuous

Easily peels off

Epithelial discontinuities

19
 Fibrous connective tissue wall
 Usually uninflamed
 Except close to junctional epithelium  chronic
inflammatory cell infiltrate

 May contain epithelial islands

20
Lateral periodontal
cyst

21
 Cysts which occur in the lateral periodontal
position and in which an inflammatory etiology
and a diagnosis of collateral keratocyst have
been excluded on clinical and histopathological
grounds

22
Clinical features
 Frequency
 0.7%

 Age
 Prominent peak in the 6th decade

 Sex
 No sex predilection
 Some studies show slight male preponderance

 Site
 Mandibular premolar area
 Anterior maxilla

23
 Clinical presentation
 Asymptomatic
 Gingival swelling on facial aspect
 Pain, tenderness on palpation
 Consistency
 Springy with egg shell crackling
 Gelatinous feel
 Associated teeth usually vital

24
Radiographic features
 Round or oval, well circumscribed
radiolucency

 Sclerotic margin

 Between the apex and cervical

margin of tooth

 Usually less than 1 cm in diameter

 Mean growth  0.7mm per year

(Rasmusson, Magnusson, Borrman,
1991)
25
Pathogenesis
 Developmental odontogenic origin

 Three possibilities
 Reduced enamel epithelium
 Remnants of dental lamina
 Cell rests of Malassez

26
 Reduced enamel
epithelium

 Arises initially as a
dentigerous cyst
developing by
expansion of the
follicle along the
lateral surface of
crown

27
 Cell rests of dental lamina (Wysocki et al,
1980)

 Cystic change in a single rest  unicystic forms

 Concomitant changes in several adjacent rests 
polycystic

29
 Cell nests of Malassez

 Occur in the periodontium

 Well positioned for a lateral periodontal cyst

 Has not received much support

30
Histopathology
 Thin, non-keratinized
squamous or cuboidal
epithelial lining

 1-5 cell layers

 Resembles reduced
enamel epithelium

 Sometimes stratified
squamous

31
 Localized plaques or
thickenings of the
epithelial lining
 Extend into the
surrounding cyst wall
 Mural bulges

 Cells are some times

fusiform with long axis
parallal to basement
membrane

 Cells of the plaque may

differentiate to take a
spinous shape
32
Glycogen rich clear cells in the epithelial lining

33
 What produces this localized
proliferations??????

 Spontaneous process occurring in odontogenic

epithelium

 Odontogenic epithelium recapitulating

ontogeny under pathological conditions

 Similar to early stages of tooth development

34
 Small epithelial nests of follicles in the
fibrous cyst wall

 Epithelial lining may separate from the cyst

wall

 Areas of juxta-epithelial hyalinization of

collagen

 Usually free of inflammation

35
Botryoid odontogenic
cyst

36
 First reported by Weathers and Waldron,
1973, who also proposed the name 
resemblance to cluster of grapes

 Variant of LPC

 Microscopically similar to LPC with some

differences

37
 Multilocular with thin fibrous connective tissue septe

 Smaller cyst cavities are oriented towards the larger

ones

 Usually lined by thin non-keratinized epithelium, 1-2

layer thick

 In some areas thicker stratified squamous epithelium

38
 Foci of plaque like thickenings

 Flat fusiform cells

 Clear cells are unusual

 Plaques show convoluted zone on electron microscopic

examination  similar to AOT (Greer & Johnson,
1988)
 May arise from stratum intermedium

 Strong expression of cytokeratin 18

39
Glandular odontogenic
cyst

40
 Sialo-odontogenic cyst

 Glandular odontogenic cyst

 Mucoepidermoid odontogenic cyst

41
 Wide age range

 Can occur in either jaws

 Propensity to grow to a
large size and to recur

 Radiologically
 Unilocular or multilocular
 Smooth or scalloped margin

42
 Histologically

 Non-keratinized stratified squamous epithelium

 Chronic inflammatory infiltration of connective tissue wall

 Superficial layer of epithelial lining

 Columnar or cuboidal cells, occasionally with cilia
 Glandular or pseudoglandular stucture
 Intraepithelial crypts or microcysts

may open onto the surface of epithelium

Papillary or corrugated surface

43
 Numerous goblet cells may be present

 Occasionally epithelium resembles REE

 Epithelial thickenings or plaques may be present

 Protrude into the cyst cavity
 Extend into the connective tissue wall

 Islands of odontogenic epithelium

 Microcysts
 Irregular calcifications
44
Commonly asked questions
 Bohn’s Nodules
 Gingival Cysts
References
Shafer, Hine,Levi. Textbook of Oral
Pathology; 5th Edition; Saunders
Publications.
Neville BW, Damm DD, Allen CM, Bouquot
JE. Oral & Maxillofacial pathology. Second
ed, W.B Sounders Company, 2002
47